Description:
The Professional Fee (ProFee) Coder is responsible for reviewing provider documentation and assigning accurate CPT, HCPCS, and ICD-10-CM codes for physician services. This role supports compliant coding, accurate charge capture, and overall revenue integrity across a variety of specialties and client environments.
Coders may support single-specialty or multi-specialty engagements depending on client needs and experience.
Requirements:
Core Responsibilities (Sage Standards)
• Review provider documentation to assign accurate CPT, HCPCS, and ICD-10-CM codes
• Ensure documentation supports coded services and identify discrepancies
• Apply appropriate modifiers, NCCI edits, and payer-specific coding rules
• Ensure compliance with CMS, AMA, and payer guidelines
• Maintain =95% coding accuracy and meet established productivity standards
• Identify documentation gaps and escalate for clarification when needed
• Participate in quality reviews, audits, and ongoing coding education
Minimum Qualifications (Sage Requirements)
• Credential: CPC, CCS-P, RHIA, or RHIT (active and in good standing)
• Experience:
• Minimum 2–3+ years professional fee coding experience
• Experience in hospital-based or physician practice environments preferred
• Strong knowledge of CPT, HCPCS, ICD-10-CM, modifiers, and NCCI edits
• Familiarity with payer policies and coding guidelines
• Ability to work independently in a remote environment
• High attention to detail with consistent quality performance
Work Model
• 100% remote
• Independent, production-focused environment with defined quality expectations
• Collaboration with coding, audit, and client teams
Employment Tracks
Full-Time (FT):
• Standard weekday coverage aligned to client volumes
PRN / Part-Time:
• Flexible scheduling to support backlog, specialty needs, or project-based work
Specialty Alignment (Core to Role Placement)
Coders are aligned to engagements based on demonstrated specialty experience. One or more specialties may be required.
Surgical Specialties (Highest Complexity)
• Cardiothoracic Surgery
• Vascular Surgery
• General Surgery
• Orthopedic Surgery
• Neurosurgery
• Surgical Oncology
• Plastics / Reconstructive
• Colorectal, Urology, ENT
Additional Expectations:
• Strong experience reviewing operative reports and procedural documentation
• Advanced modifier application (e.g., co-surgeon, assistant, multiple procedures)
• Deep understanding of NCCI edits and bundling rules
• Ability to independently code complex surgical cases
Medical & E/M-Based Specialties
• Internal Medicine / Family Medicine
• Cardiology (E&M and/or procedural)
• Gastroenterology
• Pulmonary, Nephrology, Endocrinology
• Infectious Disease, Rheumatology
• Neurology, Psychiatry
Additional Expectations:
• Strong knowledge of E&M leveling and documentation requirements
• Accurate capture of chronic conditions and medical necessity
• Ability to validate completeness and appropriateness of provider documentation
Diagnostic & Ancillary Specialties
• Radiology
• Pathology
• Anesthesiology
• Radiation Oncology
Additional Expectations:
• Understanding of specialty-specific coding structures
• Accurate use of modifiers specific to professional services (e.g., component billing)
• Consistency in applying coding conventions across high-volume workflows
General Client Expectations
• Ability to code independently within assigned specialty or specialties
• Consistent delivery of =95% coding quality and aligned productivity standards
• Adaptability to varying client workflows, systems, and documentation practices
• Effective communication with internal teams and client stakeholders
Why Sage Clinical RCM
• Exposure to diverse specialties and complex health system environments
• Flexible work options (FT, PT, and PRN)
• Quality-driven culture with realistic expectations
• Opportunity to expand into QA, audit, education, and advisory services